{"title":"Effects of online advance care planning (ACP) decision aid programmes on adults with cancer: a systematic review and meta-analysis.","authors":"Zhihao Han, Yong Fang, Jianjian Yang, Shengyang Jiang, Guiyue Ma, Xiaoqin Ma","doi":"10.1186/s12904-026-02184-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Advance care planning (ACP) is important in cancer care, but discussions are often delayed or inconsistently implemented. Online ACP decision aid programmes may support ACP participation, although their effects in adults with cancer remain unclear.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and supplementary sources was conducted from inception to 10 March 2026. Quantitative studies evaluating online ACP decision aid programmes for adults with cancer were included. Risk of bias was assessed using appropriate tools according to study design. Meta-analyses were performed using fixed- or random-effects models.</p><p><strong>Results: </strong>Twelve studies met the eligibility criteria, including 10 randomised controlled trials, 1 pre-post study, and 1 single-arm quantitative evaluation study. Most studies were conducted in the USA. Pooled evidence showed that online ACP decision aid programmes significantly improved ACP documentation (OR = 2.06, 95% CI 1.29 to 3.27, p = 0.002) and ACP engagement (MD = 0.28, 95% CI 0.15 to 0.40, p < 0.0001). No statistically significant effects were found for AD completion (OR = 1.37, 95% CI 0.54 to 3.45, p = 0.50), satisfaction (MD = 0.15, 95% CI -0.25 to 0.55, p = 0.47), decisional conflict (MD=-0.72, 95% CI -5.87 to 4.43, p = 0.78), or anxiety (MD=-0.76, 95% CI -1.67 to 0.16, p = 0.11). Sensitivity analyses suggested that the findings for ACP documentation and ACP engagement were relatively robust, whereas the results for satisfaction and anxiety were less stable.</p><p><strong>Conclusions: </strong>Online ACP decision aid programmes may support ACP in adults with cancer, particularly by improving ACP engagement and ACP documentation. However, evidence for benefits beyond ACP process outcomes remains limited or inconsistent. Further rigorous studies are needed to identify effective programme features and implementation strategies.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471503/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Palliative Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12904-026-02184-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Advance care planning (ACP) is important in cancer care, but discussions are often delayed or inconsistently implemented. Online ACP decision aid programmes may support ACP participation, although their effects in adults with cancer remain unclear.
Methods: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and supplementary sources was conducted from inception to 10 March 2026. Quantitative studies evaluating online ACP decision aid programmes for adults with cancer were included. Risk of bias was assessed using appropriate tools according to study design. Meta-analyses were performed using fixed- or random-effects models.
Results: Twelve studies met the eligibility criteria, including 10 randomised controlled trials, 1 pre-post study, and 1 single-arm quantitative evaluation study. Most studies were conducted in the USA. Pooled evidence showed that online ACP decision aid programmes significantly improved ACP documentation (OR = 2.06, 95% CI 1.29 to 3.27, p = 0.002) and ACP engagement (MD = 0.28, 95% CI 0.15 to 0.40, p < 0.0001). No statistically significant effects were found for AD completion (OR = 1.37, 95% CI 0.54 to 3.45, p = 0.50), satisfaction (MD = 0.15, 95% CI -0.25 to 0.55, p = 0.47), decisional conflict (MD=-0.72, 95% CI -5.87 to 4.43, p = 0.78), or anxiety (MD=-0.76, 95% CI -1.67 to 0.16, p = 0.11). Sensitivity analyses suggested that the findings for ACP documentation and ACP engagement were relatively robust, whereas the results for satisfaction and anxiety were less stable.
Conclusions: Online ACP decision aid programmes may support ACP in adults with cancer, particularly by improving ACP engagement and ACP documentation. However, evidence for benefits beyond ACP process outcomes remains limited or inconsistent. Further rigorous studies are needed to identify effective programme features and implementation strategies.
背景：提前护理计划（ACP）在癌症治疗中很重要，但讨论往往被推迟或不一致地实施。在线ACP决策辅助程序可能支持ACP参与，尽管它们对成年癌症患者的影响尚不清楚。方法：系统检索MEDLINE、EMBASE、CINAHL、PsycINFO、Web of Science、Cochrane图书馆、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台和补充来源，检索时间为2026年3月10日。定量研究评估在线ACP决策辅助方案对成年癌症患者的影响。根据研究设计，使用适当的工具评估偏倚风险。采用固定效应或随机效应模型进行meta分析。结果：12项研究符合入选标准，包括10项随机对照试验、1项前后研究和1项单臂定量评价研究。大多数研究是在美国进行的。综合证据显示，在线ACP决策辅助程序显著改善了ACP文件（OR = 2.06, 95% CI 1.29至3.27,p = 0.002）和ACP参与（MD = 0.28, 95% CI 0.15至0.40,p）。结论：在线ACP决策辅助程序可以支持成人癌症患者的ACP，特别是通过改善ACP参与和ACP记录。然而，ACP过程结果之外的益处证据仍然有限或不一致。需要进一步进行严格的研究，以确定有效的方案特点和执行战略。
期刊介绍：
BMC Palliative Care is an open access journal publishing original peer-reviewed research articles in the clinical, scientific, ethical and policy issues, local and international, regarding all aspects of hospice and palliative care for the dying and for those with profound suffering related to chronic illness.
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